Achievements in Public Health, 1900–1999: Changes in the Public Health System

At the beginning of this century, infectious diseases primarily due to poor hygiene and poor sanitation, and unsafe or hazardous workplaces and
occupations were the main cause of sicknesses and deaths in the United States. As the century comes to a close, chronic diseases — such as
cardiovascular diseases (heart disease and stroke) and cancer — are the leading causes of death for both American men and women. As a result, the
public health system is shifting its focus to the effects of chronic diseases, while continuing to monitor and manage infectious disease threats;
particularly, emerging infectious diseases. The partnership between local, state and federal agencies; academic institutions; and community
organizations must continue in order to successfully meet the challenges of public health in the 21st century. This report is the last in the
series, "Ten Great Public Health Achievements in the 20th century." The complete series is located online at
http://www.cdc.gov/media/tengpha.htm

Community Needs Assessment and Morbidity Surveillance Following an Earthquake — Turkey, August 1999

Rapid needs assessment is an important initial step during a disaster and can help minimize delays and inappropriate
content of relief supplies.

On August 17, 1999 an earthquake registering 7.4 on the Richter scale, stuck western Turkey. An estimated 17,000 people died; 10,000 are
missing; 24,000 were injured and 600,000 were left homeless. CDC conducted a community needs assessment in a tent city and a study of polyclinics
in two tent cities after the Turkey earthquake. Although 85% households had access to a medication source, the most common medications for
diabetes, hypertension, depression, and aches and pains (analgesics) were not available. The primary illnesses reported were upper respiratory
tract infections and musculoskeletal pain. The availability of food, water, and sanitation were well maintained after the earthquake.

Imported Dengue — Florida, 1997–1998

Dengue is being imported into Florida by travelers returning from tropical countries.

An active surveillance program implemented by the Florida Department of Health in 1997-1998 reported 18 cases of imported dengue in Florida.
Previously, over a 10-year period, about 1.3 cases were reported each year. Since there is no vaccine for dengue, travelers are urged to protect
themselves from mosquito bites by wearing protective clothing and mosquito repellant. Dengue should be considered by healthcare providers for
persons with febrile illness and a history of travel to tropical countries within 10 days of onset of symptoms. Diagnostic confirmation requires
appropriate laboratory testing. Reporting suspect as well as confirmed dengue cases is essential for prompt case follow-up, investigation for
secondary cases, public health education, and mosquito control efforts. Public health officials should consider enhanced surveillance for dengue
in areas that have widespread mosquito vectors combined with large numbers of travelers returning from dengue endemic areas.